The sickest part is the "billed to insurance" value. You get a medical bill that looks like this:

Cost: $1000

Paid by patient: $200

Billed to insurance: $800

Paid by insurance: $150

Remaining to be paid: $0

I get statements that look like this all the time, where the provider "bills" the insurance for $N, but the insurance pays a fraction of it, and apparently that's "good enough".

But when they tell me "that'll be $200 today, please, we take Visa and Discover", I don't have the option to say "actually I'm gonna pay $50 and that's good enough"

Have you tried?

I have heard that for a birth (since you have some advance notice), you can go in to the hospital, sit down, and say "I will be having a baby here, and I will pay in cash, in full. Let's hammer out some costs" and maybe actually negotiate something acceptable.

Hyper efficiency isn't about you, it's for the corporation and, to no small degree, the insurance company.

I'd have to imagine that the amortized cost (millions?) for the MRI machine, it's operation and storage, and the trained personnel isn't free, but obviously much less than you and your insurance pay.

Meant that they're only employing the exact number of doctors/nurses to meet their current capacity.

It's great for profitability, the tradeoff being when there's increased demand, it's inflexible.

That word is being used in a different way in this case. Maybe it's an economic definition of "efficient" but I'm not sure. It means they are spending bare minimum on staff/expenses to achieve whatever goals they have. Like "lean".

Efficient money making machines.